The Infertility Trap

'Individual responsibility':

Other states are caught in what seems like a painful contradiction. New Jersey has one of the toughest welfare laws in the country; since August, mothers on welfare who have more children can no longer receive increased welfare grants. Yet New Jersey spent $233,000 on fertility assistance to Medicaid recipients last year, and intends to continue such coverage. Jacqueline Tencza of the state Department of Human Services, sees nothing peculiar about a policy that enables welfare mothers to bear more children, then denies more money to raise them. The new welfare rules, she says, are meant to promote "individual responsibility": "If a woman chooses to have a child, she knows that in New Jersey either she or the father has to take responsibility for caring for that new life. It's entirely up to them."

That rationale aside, there is now a broad political consensus that welfare recipients should be discouraged from having more children. But that bipartisan effort could end up colliding with health-care reform. Under the Clinton plan, Medicaid would no longer exist-poor people would receive the same basic benefits as other Americans. Currently, fertility treatments (except for in vitro fertilization) are included in Clinton's proposal. That would mean that all states and the federal government would have to subsidize such services-for welfare mothers and everyone else. (The administration faces the same dilemma on abortions: if they're included in the basic benefit package, then poor women can receive them, and government funds will pay for them.) Linda Bergthold, co-chair of the task force that designed the benefits package, concedes that "Congress has a discussion ahead of it on what will be guaranteed for Americans." That will include weighing the right to bear children against the desire to hold down welfare costs.

PERMISSIVE STATES ..CN.-INFERTILITY ASSISTANCE TO MEDICAID RECIPIENTS

Drug treatment:

Hawaii (also pays for artificial insemination, Iowa, Louisiana, Minnesota, New Hampshire, New Jersey, New Mexico, New York, Oregon, Pennsylvania